Prescription refill pressure bothers CVS pharmacists too

"Everyone knows that if we don't hit our quotas, people can lose their jobs," one pharmacist says. Despite what CVS documents show, a spokesman says the chain does not use quotas to determine compensation.

Chris Cullum normally gets his prescriptions filled at a CVS Caremark store in San Diego. But, while traveling, he placed orders at a CVS branch in Arizona this year and at a branch in Illinois last year.

In both cases, Cullum said, he subsequently received calls from the stores in those states letting him know that refills were ready.

Two things make this noteworthy. One: Cullum, like other CVS customers who have related similar experiences, never signed up for the pharmacy's automatic-refill program, ReadyFill.

Two: Cullum is a CVS pharmacist.

He's been dispensing meds for the drugstore since CVS bought Longs Drugs in 2008. He'd been with Longs for eight years before that.

And Cullum, 52, doesn't appreciate what he says is pressure from his superiors to refill prescriptions and enroll people in ReadyFill without their approval.

"We refill prescriptions that were not ordered by the patient or the doctor," he told me. "Everyone knows that if we don't hit our quotas, people can lose their jobs."

Officials at the U.S. Justice Department and the Department of Health and Human Services are investigating whether the refill practices constitute Medicare fraud. Regulators in California and New Jersey also have launched investigations.

CVS spokesman Mike DeAngelis denied that the company pressures pharmacists to refill prescriptions or enroll customers in ReadyFill without their permission.

I've been in touch with dozens of CVS pharmacists nationwide since first reporting that the country's largest provider of prescription medication has refilled orders and submitted claims to insurers without patients' permission. Most asked that their names be withheld because of fear they could lose their jobs.

Cullum is one of two CVS pharmacists in Southern California who agreed to be identified discussing the company's operations. Both said they were frustrated with what they view as a system intended primarily to boost revenue by locking in as much repeat business as possible.

"ReadyFill is very important for CVS," said Cullum, who works at one of the company's San Diego stores. "They make sure we all know it."

Company documents previously obtained by The Times from current and former pharmacists have shown that CVS workers are expected to enroll at least 40% of patients into the program. Failure to do so can result in loss of raises or bonuses.

Other drugstores, notably Target, Rite Aid and Walgreens, have similar quotas, pharmacists at those stores have said.

"There's tremendous pressure," said Charles Franklin, 66, a pharmacist at one of CVS' Whittier stores. "You feel like your job is always on the line."

He acknowledged having enrolled customers in ReadyFill without receiving their say-so.

"You have to," Franklin said. "There's no way you can reach the 40% metric unless you do it."

What was going through his head at the time?

"I was thinking that this would allow me to hit my number for another four weeks," Franklin replied. "I was thinking that I'd have a job for another four weeks."

CVS' DeAngelis said that, despite what the company's own documents show, CVS does not use quotas to determine employees' compensation.

But emails sent to Southern California CVS pharmacists in May 2011 by Josh Wolsefer, a regional supervisor at the company's La Habra office, made clear that employees were instructed by management to refill prescriptions, or scripts, without patients' approval.

"Even if you don't necessarily get ahold of them on your calls," Wolsefer wrote, "you should be entering that they will indeed pick up their scripts."

This would improve the pharmacists' refill numbers, he pointed out, and help "get the weekly credit you deserve."

In another email several days later, Wolsefer observed that pharmacists were still coming up short in hitting their weekly refill targets.

"I am advocating … that if we don't reach a customer, that we go ahead and fill the past-due scripts," he wrote.

The emails obtained by The Times did not come from Cullum or Franklin.

Wolsefer, who has been promoted by CVS to a more senior position since the emails were written, declined to comment.

Franklin, the Whittier pharmacist, said supervisors were forthright about the company's expectations at meetings.

"They tell us that if you don't like what we're doing, you can leave," he said.

Cullum, the San Diego pharmacist, said he observed an employee in his store refilling prescriptions last year without patients' authorization.

"I asked her what was going on, and she said she'd been instructed by a supervisor to do it," Cullum recalled. "I told her to stop right away."

He said he reported the incident to CVS management by calling the company's ethics hotline.

"I never got a call back," Cullum said.

Last week, he said, the pharmacy manager from a CVS store in La Jolla showed up at his store and started entering refills into the computer without patients' consent.

"She told me our numbers were too low and she'd been told by a supervisor to make them look higher," Cullum said.

I related what I was hearing to CVS' DeAngelis. I also shared the contents of Wolsefer's emails.

DeAngelis responded with an official statement:

"As we have said previously, we are committed to ensuring that all of our business operations adhere to the highest ethical standards," he said.

"Any suggestions that our pharmacists or supervisors are violating company policies in relation to our pharmacy programs, including ReadyFill, are taken seriously and will be investigated and addressed."

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5 and followed on Twitter @Davidlaz. Send tips or feedback to david.lazarus@latimes.com.